Health Management Information System

(HMIS) and Human Resource Information

System (HuRIS) in Nepal

Sagar Parajuli
MPH (PHSM) Third Semester 2023
School of Health & Allied Sciences
Pokhara University
Presentation Outlines

 Health Management Information System (HMIS) in Nepal

- Introduction
- Origin & Development
- Role, Importance and Implications
- Review and Critical Appraisal
 Human Resource Information System (HuRIS) in Nepal
- Introduction
- Origin & Development
- Review and Critical Appraisal
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Information System in Health
Health
“ A health information system Information
can be defined as an integrated System

effort to collect, process, report Health Human

Facilities Resource
and use health information and Information Information
System System
knowledge to influence policy- Information
System in
making, program action, and Health
research”
- WHO 2003 Health Service
Disease Delivery
One of among six Health System Surveillance Information
Building Blocks System System

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Information System in Health
HMIS
IPD FMIS
Types of Information System
 Routine Information: HMIS EHRS LMIS
 Disease Surveillance: EWARS, MDS
 Logistics: LMIS EMRS HIIS
Routine
 Financial Management: FMIS Health
 Infrastructure: HIIS HFR Information PLAMAHS
Systems
 Human Resource: HRH, TMIS
 Assets: PLAMAHS HBIS HuRIS
 Drug: DIN
EWARS TMIS
 Ayurveda: AHMIS
DIN AHIMS
 Insurance: HBIS
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Health Management Information System (HMIS) in Nepal

Sources of Health Information

 Routine Health Information
System
 Facility based Information
 Population based Information
(Housing & Population Surveys)
 Disease Surveillance
 Vital registration
Source: IHMIS Roadmap 2022-2030

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HMIS: Origin and Development in Nepal (AD)

• Initiation of Program Reporting for Malaria Eradication Program

1958
• Integration of all vertical reporting system
1994 • Health Management Information System (HMIS) Introduced; 38 forms
• Piloting of Health Sector Information System (HSIS) in Lalitpur, Parsa &
2007 Rupendehi (2064-68 BS / 2007-2011 AD

• HMIS Online reporting from D(P)HOs, HFs and LGs 2015 onwards
2015
• Revision of HMIS Tools
2020 • IHMIS Roadmap 2022-2030 approved by the cabinet

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HMIS: Major Milestones in Development

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Health Management Information System (HMIS) in Nepal

Use of DHIS-2 for Routine HMIS

• Free open source software
developed by Oslo University,
Norway and implemented more
• In use more than 67 countries over
the world to manage the Health
sector recording and reporting .
• DHIS 2.30 version currently in use

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Health Management Information System (HMIS) in Nepal

Key Features
• Online entry and reporting
• Data Access based on need
• Dashboard & Data visualizer
• Pivot table, GIS
• Data quality modules
• Event Capture
• Standard reports
• Feedback and messaging

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Institutional Framework for HMIS
Ministry of Health and
 IHMIS Section responsible for HMIS in Nepal: Population (MoHP)
- Formulating policy and guidelines related to the national
level HMIS,
- Effective management of health information, Department of Health
- Integration of existing health system and Services (DoHS)
interoperability,
- Develop and modify indicators and reporting
mechanism, prepare annual report Management Division
 Planning, monitoring and regulation section under
PHD responsible for overall health information
management in the province level. IHMIS Section
 Health section under the local level
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HMIS Revision 2019/2020 AD
HMIS Recording and Reporting Tools before revision Updated: HMIS Recording and Reporting Tools
SN Sub no. Group SN Sub no. Group
1 1.1 -1.6 Common forms-6 1 1.1 -1.8 Common forms -8
2 2.1 – 2.7 Infants and child health-7 2 2.1 – 2.8 Infants and child health-8
3 3.1 – 3.7 Maternal and Neonatal
Health -7 3 3.1 – 3.8 Maternal and Neonatal
Health-12
4 4.1 – 4.3 Community services-3
4 4.1 – 4.4 Community services-4 Total Forms:73
5 5.1 – 5.6 Malaria, Kalazaar & 68 Recording

(53 Recording + 5 Reporting)

(68 Recording + 5 Reporting)

Leprosy, Geriatric -6 5 5.1 – 5.10 Malaria, Kalazaar & 5 Reporting
Leprosy, Geriatric -10
Total Forms: 58

Total Forms: 73
6 6.1 – Tuberculosis -15
6.10 6 6.1 – 6.10 Tuberculosis -15

7 7.1 – 7.6 HIV/AIDS & STI-6 7 7.1 – 7.6 HIV/AIDS & STI-5

8 8.1 – 8.3 Hospital -3 8 8.1 – 8.6 Hospital-6

9 9.1 – 9.5 Reporting forms - 5 9 9.1 – 9.5 Reporting forms - 5

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HMIS Revision 2019/20 AD

15 new tools covering five

different program
- RH morbidity,
- NCD and Mental health,
- Geriatric,
- OCMC,
- SSU,
- NRH,
- HPE register,
- Abortion service cards,
- Rehabilitation service card
and register and
- SNCU/NICU register

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Health Management Information System (HMIS) in Nepal
SN Previous Now
Program # % # of % %
indicators indicators change
1 Safe motherhood/MNH 36 13.6 47 12.8 30.6
2 Family planning 2 0.8 3 0.8 50.0
3 Female community health volunteers 10 3.8 7 1.9 -30.0
4 Primary health care outreach services 4 1.5 3 0.8 -25.0
5 Immunization 28 10.6 32 8.7 14.3
6 Integrated management of childhood illnesses 31 11.7 31 8.5 0.0
7 Nutrition 25 9.4 34 9.3 36.0
8 HIV/AIDS 24 9.1 16 4.4 -33.3
9 Tuberculosis 18 6.8 8 2.2 -55.6
10 Epidemiology and disease control (Malaria, Kalazar, 33 12.4 78 21.3 136.4
Leprosy, NCD & Mental Health, Injury)
11 Curative services 26 9.8 31 8.5 19.2
12 Health facilities(service availability, MSS, reporting 28 10.6 23 6.3 -17.9
and data quality)
13 RH morbidity- New Added 5 1.4
  Population Program (OCMC/SSU/Geriatric)-New 46 12.6
Added
Health promotion and education-New Added 2 0.5
Total 265 100.0 366 100.0

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HMIS Role, Importance and Implications
 Assessment of population health
 Health Care Delivery monitoring
and evaluation
 Program performance evaluation
 Process Implementation
 Evidence-based actions
 Program and policy development
 Resource evaluation
 Health Alerts and Warning
 Preparedness, planning and
readiness
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HMIS Role, Importance and Implications
 Health System Strengthening
 Human resource planning
 Infrastructure and Health Facilities
Mapping
 Development of targeted intervention
based on data disaggregation;
implications of need-based approach
 Tracking National targets and global
commitments

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Critical Appraisal on HMIS

 Policies Commitment for strengthening HMIS; National Health Policy

2019, Nepal Health Sector Strategy 2022-2030, IHMIS Roadmap
 Development of National e-health strategy; leveraging Modern
technologies for better health information system
 Designated sections and authorities with required HR at all levels
 User-friendly system i.e., DHIS-2
 Allows disaggregation of data based on caste, ethnicity, age, sex and
disease and improved use of data at different levels
 Improved quality of data, focus at the point of data generation, i.e. at
HF level
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Critical Appraisal on HMIS

 Reporting: Irregular, Incomplete and inconsistent, under reporting

 Weak coverage and reporting status: 88% public hospital only
reporting national status, 69% public hospitals and 67% FCHVs
reporting in Bagmati (Annual Report 2021/22, DoHS-MoHP)
 Data Discrepancy : Difference in data reported and recorded, need
of RDQA and Data Quality Review (DQR)
 Internet Connectivity, device availability and reluctancy
55% of health facilities have computers with internet connectivity- NHFS 2021
 Poor Monitoring and supervision system for data
 Need of interoperability between different information system like
MDIS, EWARS and DHIS-2 for Malaria
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Critical Appraisal on HMIS

 Need of onsite coaching and mentoring for data recording and

reporting
 Need of Health Sector Information Strategy (Drafting on process)
 Need of national data security and protection strategy, in line with
international standards for data storage and use- HL7 (range of
global standards for the transfer of clinical and administrative
health data between applications)
 Orientation, Training and capacity development: Hands on skill
development training on DHIS-2, EWARS

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Critical Appraisal on HMIS

Under Development
Information System

• Electronic Health Record

• Electronic Medical Record
• Health Data Directory
• Patient/Client Registry
• E-Governance

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Human Resource Information System
(HuRIS) in Nepal
Human Resource Information System

 System with HR related data, information, personnel information,

tools and transactions.
HRIS or HuRIS HuRDIS HRMS HCMS (Human Capital)
General/broad Specific term for HRD Overall Human Managing the entire employee life
term for HRM Application of HRIS in Resource cycle from recruitment to
aspects of HRD Management retirement.

 Record keeping system of HR including categorization of existing

human resource by socio-demographic characteristics, job category,
skills and qualifications, hierarchy… etc
 Intersection of human resources and information technology
through HR Software, nowadays called as e-HR
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Human Resource Information System Types

Employee Operations Job Design & Analytics Workforce planning Combination of all
Recruitment HR Functions Operational, Tactical
Benefits and Strategic HRIS
Compensation

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Human Resource Information System Functions
 Personal Administration
 Recruitment and retention
 Time and Labor Management
 Payroll Functions
 Benefits Management
 Performance Appraisal
 Reward Management
 Leave & Employee Services
 Trainings Information
 HR Analytics & Reporting
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Human Resource Information System Functions & Benefits

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Minimum Data Set for HRH Registry- WHO

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HuRIS in Nepal; Origin and Development

 GTZ provided Technical Assistance to support

HuRDISH (later known as HuRIS) from 1993
to 2007 for strengthening Human Resource
Information System in Nepal
 HuRIS upgraded on 2007 to Oracle to enable
districts for remote data capture using the
Internet.
 Standard internationally used database
 Staff in 73 out of 75 districts were trained in
entering data into HuRIS
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HuRDIS in National Strategy

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Personal Information System (PIS)

 Managed by MoFAGA
 Originally access database for the whole
public sector.
 Upgraded to a fully functional HRIS
database, using Oracle 9i and Redhat Linux.
 Advantage of remote data capture
 Implemented with WorldLink Technologies
 Civil service wide system, devolved to
support the main aspects of human
resource administration.
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HuRIS vs PIS

• Fundamental difference between HuRIS and PIS

- HuRIS does not perform an administrative function, while PIS does
• PIS; kept up-to-date to administer employee records while HuRIS not
up to date
• HRIS contains: personal details, education and training, appraisal,
transfer, promotion, disciplinary action, post, location and
employment base while PIS particularly focused on all employee
record

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HuRIS vs PIS

Features HuRIS PIS

Scope Health only All Civil services
Type of database Oracle Oracle
Remote data capture using Yes Yes
internet
Administrative/Operation role No Yes
Validation Exercise No Yes
Data Accuracy Questioned Yes
Standard reports for workforce Yes Yet to be written
statistics

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Critical Appraisal on HuRIS & PIS
Policy Commitment and New Initatives
 Development of National HRH strategy Roadmap and IHMIS
Roadmap 2022-2030 prioritizing ‘need of strengthening human
resource information system’
 Workload Indicators and Staffing Norms (WISN) piloting
 Integrated HRH database i.e, iHRIS software implemented through
two professional councils (Nepal Pharmacy Council and Nepal
Ayurvedic Medical Council) with the plan to extend to other
remaining professional councils
 Planning of information system integration and inter-
operationability
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Critical Appraisal on HuRIS & PIS

 Inconsistent classification of staffs and not up to date HuRIS

 No effective use of ‘HuRIS’ and still traditional practices
“the present human resource information system HuRIS is not up-
to-date and is believed to contain only three-fourths of the total
personnel (Ministry of Health and Population, 2010).”
 Need of integration of PIS, HuRIS and TIMS
 Need of routine information collection, timely update and time series
report publication for HRH analysis (Need, Demand, Status)

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Critical Appraisal on HuRIS & PIS

 Monitoring and evaluation of Information System essential

 Projection and Estimation of HR Needs based on HuRIS
 Limited information available on HuRIS and PIS

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Critical Appraisal on HuRIS & PIS

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Way Forward

 Integration and ensuring interoperability between PIS, HuRIS and

TIMS creating an employee profile from recruitment to retirement
 Capacity development and Training on using Human Resource
Information System
 Ensuring data validation time and again
 Report generation, dissemination and evidence-based or data-driven
HRH planning catering need of the Country
 Developing Integrated HRH database in coordination with Councils
and Academia

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References
1. Health Management Information System [Internet]. [cited 2019 Aug 13]. Available from:
https://dohs.gov.np/information-systems/health-management-information-section
2. HR_MIS_assessment_september2011.pdf [Internet]. [cited 2023 Jul 27];Available from:
https://www.nhssp.org.np/NHSSP_Archives/human_resources/HR_MIS_assessment_september2
011.pdf
3. Improving the use of HMIS for Evidence Based Decision.pdf [Internet]. [cited 2023 Jul
27];Available from:
https://www.nhssp.org.np/Resources/EA/Improving%20the%20use%20of%20HMIS%20for%2
0Evidence%20Based%20Decision.pdf
4. NHSSP Achievements Learning and Future Approaches.pdf [Internet]. [cited 2023 Jul 27];Available
from:
https://www.nhssp.org.np/Resources/QuarterlyReport/NHSSP%20Achievements%20Learning
%20and%20Future%20Approaches.pdf
5. Health management information system [Internet]. [cited 2023 Jul 27];Available from:
https://www.slideshare.net/stephipoulose/health-management-information-system-60612975

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References
6. Integrated Health Information Management Section – Department of Health Services [Internet].
[cited 2023 Jul 27];Available from:
https://dohs.gov.np/integrated-health-information-management-section/
7. Health information system transformation framework for decision making [Internet]. 2021
[cited 2023 Jul 27];Available from:
https://www.slideteam.net/health-information-system-transformation-framework-for-decision-
making.html
8. Marasini B. Health System Development in Nepal. JNMA J Nepal Med Assoc 2020;58(221):65–8.
9. SHRESTHA MR. [Nepal]Present Progress of Information Technology in Health Care System of
Nepal. Jpn Med Assoc J JMAJ 2014;57(4):203–6. https://pubmed.ncbi.nlm.nih.gov/32335645/
10. DFID/Nepal Health Sector Programme III (NHSP 3), Framework for improved management of
health information in the context of federal governance structures in Nepal June 2017
https://www.nhssp.org.np/Resources/EA/Framework_for_Improved_Health_MIS_June2017.pdf

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 Thank You!
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